Objective To explore the predictive value of immediate imaging evaluation after drug-coated balloon (DCB) surgery for early recurrent angina pectoris in patients with coronary heart disease.

Methods A retrospective study was conducted. A total of 68 patients with coronary heart disease who received DCB treatment and had complete postoperative angiographic data were continuously included. The general information of the patients and cardiovascular risk factors, and simultaneously record the anatomical characteristics of the lesions (including the number of lesion vessels and location of the target lesion) and parameters related to interventional operations (including the specifications of the pre-dilation balloon, diameter and length of the DCB and dilation pressure, etc.) were collected. The immediate postoperative angiography images were independently interpreted by two physicians with interventional experience under blind conditions. The imaging indicators such as the degree of residual stenosis, TIMI blood flow grade, severity of dissection and elastic retraction were recorded, and a composite imaging quantitative score was constructed. Taking whether angina pectoris occurred within 1 month after the operation as the outcome indicator, the differences in imaging features and operating parameters between the recurrent angina pectoris group and non-recurrent angina pectoris group were compared. Multivariate logistic regression analysis was used to screen the independent risk factors, and the efficacy of each imaging index and composite imaging quantitative score in predicting early recurrent angina pectoris was evaluated using the receiver operating characteristic curve (ROC).

Results The patients were followed up for one month after operation. Among the 68 patients, 11 cases had recurrent angina pectoris, and 57 cases did not have recurrent angina pectoris. The proportion of three-vessel lesions in the recurrent angina pectoris group was significantly higher than that in the non-recurrent angina pectoris group, and there were statistically significant differences in the postoperative angiographic dissection severity score, elastic retraction score and composite imaging quantitative score between two groups (P ＜ 0.05). The logistic univariate regression analysis showed that the number of diseased blood vessels (OR = 2.293, 95%CI: 1.007–5.244), elastic retraction score (OR = 9.331, 95%CI: 2.263–38.608), postoperative dissection severity score (OR = 2.271, 95%CI: 1.083–4.759) and composite imaging quantitative score (OR = 2.052, 95%CI: 1.227–3.269) were associated with the occurrence of early postoperative recurrent angina pectoris (P ＜ 0.05). The results of multivariate logistic regression analysis showed that only the combined imaging quantitative score was an independent risk factor (OR = 1.878, 95%CI: 1.128–3.126, P ＜ 0.05). The results of ROC curve analysis showed that the sensitivity of the composite imaging quantitative score in predicting early postoperative recurrence of angina pectoris was 63.60%, the specificity was 89.50%, and the AUC was 0.797 (95%CI: 0.645–0.950, P ＜ 0.01). Its overall discriminative ability was superior to that of a single imaging indicator.

Conclusions The immediate imaging assessment after DCB in patients with coronary heart disease is closely related to the early recurrence of angina pectoris after surgery. The composite imaging quantitative score has a better risk identification ability than a single imaging index and can provide imaging evidence for the early risk stratification and follow-up management after DCB.